One Minute Wellness: Sloppy Push Up

This unprecedented time of COVID-19 has many of us working from home, going out less, driving less… basically everything is “less”… except sitting. Most of us are sitting around the house like never before, and most people will be slouching for long periods.

Over time, this can put your lower back in a less-than-happy place, so you can try to prevent that– or help it– by trying this simple move. The “sloppy” push up should not be painful. Ideally it should actually feel like nothing, which is weird to think like that: we generally don’t do movements or exercises that don’t feel like they’re stretching or working muscles. But the thing is that this movement should feel smooth and easy, and you’re trying to keep your muscles relaxed. If it is painful, check with your physiotherapist to see if it is right for you.

Sloppy push ups are brilliant!

9 HELPFUL BACK PAIN FACTS



1. Most back pain is not a serious, life-threatening condition.

2. A weak core does not cause back pain, ever. Really.

3. Feeling like you won’t get better and avoiding moving around can make the pain last longer.

4. Imaging of the back (Xray, MRI) do not determine outcomes or how long pain lasts. Often they are not helpful at all.

5. Graduated exercise and movement in all directions is safe and healthy for the spine.

6. Spine posture during sitting, standing and lifting does not predict back pain or its persistence.

7. Pain flare-ups are more related to changes in activity, stress and mood rather than structural damage.

8. Spine movement and loading is safe and builds structural resilience when it is done regularly and properly.  Effective care for LBP is relatively cheap and safe. This includes: education that is patient-centred and fosters a positive mindset, and coaching people to optimise their physical and mental health (such as engaging in physical activity and exercise, social activities, healthy sleep habits and body weight and remaining in employment).

At Elevation Physiotherapy & Wellness, we are very good at helping people through their back pain to get to the source of the problem and getting them back to full life!

Get better, faster.

Back to basics: 10 facts every person should know about back pain. Peter B O’Sullivan et al. British Journal of Sorts Medicine. Editorial. Dec 2019

Exercises for Lower Back Pain Are NOT Created Equal!

Elevation Physiotherapy & Wellness :: Exercises for Lower Back Pain Are NOT Created Equal!

Research has shown that people suffering from lower back pain should focus on just two things:  keep moving, and be careful with sitting posture and avoid slouching.  There has been more recent research studying if specific directional exercises are more valuable to get rid of pain, or if general stretching and strengthening around the spine is more effective.

A directional preference is described as when repeated lower back movements in one specific direction (eg. arching the back) demonstrates quick improvements in pain and range of motion that remain better as a result.  This phenomenon doesn’t always happen, but when people’s back pain responds so nicely to repeated movements into one direction, they often progress faster than those who do not demonstrate any directional preference. Long et al (2004) developed a brilliant study where they identified those people who showed a directional preference to a lower back movement, and asked would happen if the person did not continue with exercise in their direction of preference?

 Three hundred twelve people with lower back pain had an assessment to determine who demonstrated a directional preference with lower back movements.  Those who did (n=230) were placed into one of three directional subgroups:  flexion (rounding), extension (arching) or lateral (sideways) preference. Each subgroup was then randomized into a matched (n=80), opposite (n=70), or non-directional exercise program (n=80).   All 3 groups were given education on posture and keeping active as able. For example, if one person showed a directional preference for lumbar extension (arching back) during their assessment, they were then randomly allocated to continue with exercises into lumbar extension (matched preference), or lumbar flexion exercises (opposite), or a third control group of generalized strengthening and stretching exercises of the lower back, hips and thighs (commonly prescribed multi-directional mid-range exercises).

Elevation Physiotherapy & Wellness :: Lower Back Pain Testing

After two weeks, 95% of the people doing the exercises in their preferred matched direction were improved or completely better and no one was worse. Yes, you read that right—95%!!!

This was over four times better than the group performing the opposite movement to their direction of preference (23% better or resolved and 15% reported being worse). The control general exercise group had 45% report they were improved and  15% were worse, but interestingly, 55% of these control group did not feel they were improved despite performing commonly prescribed exercises and general movement.  This study strongly demonstrates how individualized directional exercises can be very powerful to improve or resolve back pain quickly.  One does not have to suffer for weeks or longer to help the source of the problem.  A proper mechanical assessment can determine the proper course of action to help get better, faster… and stay that way!

Reference:

Long, A. et al.. Does it matter which exercise? A randomized control trial of exercise for low back pain.2004, Spine 29(23): 2593-2602

Gardening Tips for Spring

Gardening can be a form of exercise. Doing basic gardening tasks such as weeding, trimming

and raking can burn up to 300 calories an hour. It’s a good way to maintain flexibility and range of motion in your shoulders, hips and back, as well as building strength and endurance. Avoid pain and injury by starting with planned shortened sessions and gradually increase activities.

USE PROPER BODY MECHANICS
When digging or raking, make sure your neck and back are fairly straight, and you’re not holding a position where you’re rounding forward—be upright, and use your legs to move around, not reaching over with your arms! Always bend from the hip joint to keep your back straight, and not from the waist.  When lifting, try to “hinge” from the hips and use your legs.

Continue reading →

Say “Yes” to Exercise for Back Pain

An interesting article where I both wholeheartedly agree and don’t agree: the researchers report that “the best form of exercise is the one that you are going to stick with”. Exercise in the form of general movement is generally fantastic, but often there are specific directions/ movements that could actually help repair the problem– read more 

If this interests you, you will find the blog from July to be a great read.

View original article:  www.scientificamerican.com

 

What 4 Things to do FIRST When Back Pain Begins

  1. Stop trying to figure out WHY and just get on with it!

Of course, pain is not normal– it’s your body telling you that something is going on. You do need to pay some attention. Most of the time back pain begins for no obvious reason– you could just wake up with it, or some harmless movement like bending forward to pick something up starts a sudden pain. When this happens, it’s scary. It’s also human nature to wonder what the heck happened, and you can wrack your brain to try to figure it out, but most of the time you won’t know for sure. Most commonly it is cumulative stressors to your back that creates the problem– it finally just has enough, then you’ll do something innocuous– like wash your foot, and you can’t get up. Try to keep moving as best as you can.

  1. How much are you sitting? HOW are you sitting?

It has been shown that people who have desk jobs have more of a risk of back pain than construction workers. Sitting is hard for your back, and your body is meant to move. In life, many people spend WAY too much time sitting– not just at the computer, but traveling to and from work or school, sitting to eat all of your meals, and all entertainment (TV, out for dinner or a pub, reading)– all sitting!

If you’ve been sitting in any chair for awhile, odds are you’re relaxed into it and assumed a slouching position. This slumped posture is the same thing as being fully bent forward as far as your back goes. Fully. Forward. Evidence shows this is a position of vulnerability for your back, and how much do you do it? Every day, likely for long periods. For details on correcting your sitting posture, refer to the post on proper sitting posture.

  1. WHERE is the pain?

Does your back pain stay local, or do you feel something in your butt? Your leg? Is it all on one side or is it both? Does it come and go, or is it truly always there? All important questions you need to assess. If you’re feeling pain away from your back into your butt or lower, that pain is likely referred from your back itself. Even if your leg hurts more than your back, it’s very common that the source of this pain is coming from your back. Location, location, location. It’s the radiating leg pain that you want to address first, and start looking at different back positions to see if any can help the pain.

  1. WHAT happens when you lie on your stomach?

This can be a weird movement for some, and many people never spend time in this position. Lying down on your stomach keeps you not weight-bearing through your back, and has your spine in a fairly neutral position. Try to be here for a few minutes, and just see if any back, buttock or leg pain starts to settle down. This is a positive sign when that happens, but don’t worry if you don’t notice any change.

The most efficient thing to do from here is get to your Physiotherapist or Chiropractor. This person should be asking you the above questions, and you can easily give them this information– this will help form an individualized program that will help you settle this pain quickly, then work to prevent this from happening again!

How Do You Sit?

I’m sure you’ve heard by now that sitting is the new smoking. Many people spend WAAAYYYY too much time each and every day sitting– commuting to work, eating all of your meals, sitting at your desk, and all entertainment (reading, watching TV, dining out, going to a movie or theatre) — yep… all sitting.

Do you ever think about HOW you’re sitting?  Odds are, you tend to slouch in your chair after you’ve been there for awhile. This slumping position keeps your back fully rounded forward and over time, some of the structures can become irritated and cause you pain. People often don’t realize how often in life we get into this fully bent forward position!

Even an “ergonomic” chair that will have some curve built in is often not enough to prevent your pelvis from tipping backward so that your back is rounded.  Many people find it helpful to use a supplemental lumbar roll. This round cushion is firm enough that when you sit and relax into it, your pelvis is not able to tip back, allowing your back to maintain the normal curves that are there when you’re standing.

There are manufactured lumbar rolls you can buy, and we like the McKenzie Lumbar Roll or McKenzie Super-roll because they are firm. We do not receive any money or gain from mentioning this product specifically, we just like them best and this is what we sell at the clinic.  Alternatively, you can make a supplemental lumbar roll by folding a towel in half length-wise and rolling it up so that the roll is about 10-15 cm (~4-5″) in diameter.  Be sure to wrap some tape or elastic bands around it because if you’re constantly having to re-roll it, you won’t use it for long!

Once you have your lumbar roll, sit down in the chair with your buttocks close to the back of the seat, push the lumbar roll down until it hits the top of your butt, and relax around it. The roll should be where your back has it’s natural inward curve, and is just there to support it. Now try to slouch– the roll should be firm enough that it prevents your pelvis from tipping backward.

Often we hear that the roll feels too big or intrusive, and that is because so many people sit slouched that it starts to feel normal, and even a correction toward neutral seems exaggerated. It definitely takes some getting used to! That said, it shouldn’t be aggravating to any back pain that you feel.  If it seems to irritate your back, then you should speak with your Physiotherapist or Doctor to determine if a modification would be better for your back.

A Very Cool Study: Directional Preference in Action

In a previous blog, I was mentioning the McKenzie System of Mechanical Diagnosis and Therapy (MDT) and outlined what a “directional preference” is: the assessor is trying to determine if the person with back pain has one direction of movement that they can do repeatedly that will consistently decrease their pain or increase their movement.

There is a huge and growing area of research dedicated to the McKenzie system, and I want to outline perhaps my favourite study of back pain of all time! Audrey Long is the lead researcher for this study, and she is a Physiotherapist and McKenzie Faculty in Alberta, Canada. She and her team examined over 300 people with lower back pain, and was able to categorize 230 people who demonstrated a directional preference into flexion (bending forward), extension (bending backward) or lateral (sideways)—performing repeated movements into their direction of preference would lessen their pain consistently. These people were then randomized to continue, as homework for 2 weeks, repeated movements several times per day into their 1) direction of preference, or 2) the movement opposite to their direction of preference, or 3) the control group, which was assigned general stretches and strengthening of the back and hips.

People worked on this consistently, and after 2 weeks, the >90% of the group that worked into their direction of preference reported being improved or resolved. That is HUGE! It’s not often in research that you get such dramatic results. This group also reported having to take much less medication than initially, and their level of function had significantly improved.

Interestingly, 23% of the group that worked into the direction of movement opposite to their direction of preference showed improvement, and 15% of that group and the control group reported being worse. You don’t start doing exercises that make you worse as the days go on!

This study really demonstrates how important it is to determine if you have a direction of movement preference that consistently lessens pain or increases movement, as that can really allow back pain to move along quickly!

The study is called:  Does It Matter What Exercise? A randomized contol trial of exercises for low back pain. (2004) Spine. 29(23): 2593-2602 by Long, A., Donelson, R., Fung, T